Covid-19 associated shoulder girdle calcific myositis: a novel entity

Abstract

Objective: To investigate the prevalence, describe the radiological features, and consider the clinical sequelae of COVID-19- associated shoulder girdle calcific myositis.

Methods: All patients who underwent a CT pulmonary angiogram study at our institution (Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom) in April and May 2020, January 2021, and July 2021 were included. A total of 1239 CT pulmonary angiogram studies for 1201 patients were reviewed. Patients with COVID-19 and associated shoulder girdle calcific myositis were identified. Their electronic patient records were reviewed. The patients' demographics, serum inflammatory markers, and proning history were recorded.

Results: Of the 364 patients in Wave 1, 71 patients (19.5%) had COVID-19, and of those, 2 patients (2.8%) had shoulder girdle calcific myositis. Of the 521 patients in Wave 2, 354 patients (67.9%) had COVID-19, and of those, 3 patients (0.8%) had shoulder girdle calcific myositis. Of the 316 patients in Wave 3, 37 patients (11.7%) had COVID-19, and of those, 1 patient (2.7%) had shoulder girdle calcific myositis. The overall prevalence was 1.3%. The most common site of calcific myositis was within the subscapularis muscle.

Conclusion: COVID-19-associated shoulder girdle calcific myositis is a rare extrapulmonary musculoskeletal manifestation of COVID-19. Early recognition and increased awareness of this disease entity, in our experience, aids in reducing patient morbidity and improving long-term functional outcome.

Advances in knowledge: We have reported a novel disease entity associated with COVID-19, in the form of shoulder girdle calcific myositis. We have described the common imaging features and discussed our experience of management and clinical sequelae.

Figure 1.

CK and CRP levels for ICU patient ‘a’. CK, creatine kinase; CRP, C-reactive protein; ICU, intensive care unit.

Figure 2.

CK and CRP levels for ICU patient ‘b’. CK, creatine kinase; CRP, C-reactive protein; ICU, intensive care unit.

Figure 3.

CTPA images axial mediastinal windows showing calcific myositis within (a) bilateral infraspinatus muscles and (b) left subscapularis and biceps muscles. CTPA, CT pulmonary angiography.

Figure 4.

CTPA images axial mediastinal windows showing calcific myositis within (a) right subscapularis muscle and (b) left subscapularis muscle. CTPA, CT pulmonary angiography.

Figure 5.

CTPA images axial mediastinal windows showing calcific myositis for two different patients, (a) and (b), within the right infraspinatus muscles. CTPA, CT pulmonary angiography.

Figure 6.

Left shoulder radiograph images (a) AP and (b) axillary views, showing ossification anterior and medial to the anatomical and surgical neck of the humerus and inferior to the glenoid neck. AP, anteroposterior.

Figure 7.

CTPA images axial mediastinal windows showing (a) left subscapularis intramuscular bony fragments secondary to previous comminuted displaced humeral head fracture and right subscapularis artefact due to adjacent beam hardening due to adjacent intense venous contrast, (b) left glenohumeral joint intra-articular bony ossicles secondary to severe osteoarthritis, (c) and (d) high density streaks projected over the right subscapularis muscles secondary to beam hardening artefact from the scapula. CTPA, CT pulmonary angiography.